April 10, 2019: T.R. Reid — U.S. Could Provide Health Care For Everyone State By State

Industrial nations worldwide offer universal health care in several forms, while the United States lags and may — on a federal level — lack the political will or capability to make a significant change, according to panelists who spoke Wednesday at the Oregon Health Forum.

State-by-state action may be needed for real change in delivering and paying for health care in America, a pattern that has been followed for several other significant changes in the country, said featured guest speaker T.R. Reid, the author of the book, “The Healing of America.”

“Washington, D.C., is not capable of pulling this off,” said Reid, a longtime Washington Post correspondent and National Public Radio contributor. “The way we’re going to get to universal health care in the United States is state-by-state — that is one or two or three states are going to come up with this system to provide health care for everybody at a reasonable cost. The other states will see that it worked, and we’ll get there.”

Reid was one of four participants on the panel, “Universal Healthcare Without Single Payer,” held at Multnomah Athletic Club in Southwest Portland. The Oregon Health Forum is a nonprofit affiliated with The Lund Report.

Other speakers included Sarah Friend, executive vice president of sales and marketing for The Partners Group in Portland; Dr. Richard Jamison, general surgeon and president of The Oregon Clinic; and Dr. Knute Buehler, an orthopedic surgeon from Bend and recent Republican candidate for governor who served as the 54th district Oregon state representative for 2015 to January. Brian DeVore, CEO of Sifft Consulting, moderated the forum, attended by about 130 people.

Reid, in suggesting a states-led reform of American health care, pointed to historical shifts in the country that started with one state then eventually became the law of the land: women’s suffrage, minimum wage laws, child labor laws, free public education, interracial marriage, same-sex marriage and recreational marijuana.

“Oregon is a very likely prospect to get this done,” said Reid, who gave a shoutout at the beginning of his talk to the health care transformation work of former Gov. John Kitzhaber. “You’ve gotten stuff through your Legislature. You had a Republican candidate for governor who got it. … So, this a place that could lead our nation. So keep working at it. Don’t give up, please.”

In his opening remarks, Buehler asked, “How do you set the floor and how do you set the ceiling of coverage for any population,” he said. “Certainly people in this state have wrestled with that question for decades.”

Buehler was referring to creating health plans that would establish minimum levels of care but would potentially rule out services and procedures — panelists mentioned botox injections — that would not be covered.

Reid acknowledged that the several industrialized countries that he cited that provided health care for all of its citizens, did not provide all types of services. He recalled a conversation with the head of the National Health Service in Britain.

The system spends about 44 percent as much per capita on health care as the U.S. and has somewhat better health statistics while covering all citizens, Reid said.

“And I asked the head of the NHS how he does it,” Reid said. “And he said, ‘Well, we have a simple rule. We cover everybody, but we don’t cover everything. We have a pattern — a floor of treatment — that everybody gets. We want you to get it. But there are just some things we’re not going to pay for.”

Botox injections, hair replacement and breast augmentation, for example, would not be covered. Even a right shoulder ailment that ails Reid — he can lift the limb almost to shoulder level but that’s it — would not be covered, the journalist said.

Reid, who lived in Britain at one point in his Post career, described telling his personal physician about the painful shoulder. The shoulder didn’t meet Britain’s floor, he said.

“He said, ‘Well, go home. Go home and live with it. Because we’re not going to fix that.’ He says, ‘You’re living your life, you’re a successful journalist, you’re a skier. You’re doing fine. We’re not going to fix that.’ So, there are things they’re stingy about.”

The same physician rejected Reid’s suggestion that he get a standard prostate cancer test. He told Reid at the time the British medical community believed the test was not cost effective — a position that recently has gained traction in the United States. At the time, though, Reid said if a test could tell him whether or not he had cancer, he believed that was a good test to have.

Buehler later asked how a decision rejecting shoulder treatment could be justified, pointing out the circumstances would be much different if the worker seeing the doctor was a carpenter whose livelihood depended on the use of a healthy arm. (An orthopedic surgeon, he suggested that Reid schedule a side trip to Bend and see an orthopedist to get it taken care of.)

Friend, too, said the drawbacks to universal care systems must be considered along with the benefits.

The longtime health insurance executive pointed to information she’d gleaned from Japan’s health care system — partly through her son’s immersive interest in the country as well as others, including Germany.

“The biggest losers in those systems are the doctors and the hospitals,” Friends said. “About 50 percent of the hospitals in Germany and Japan are running at a deficit because one of the biggest ways they control costs is by significantly limiting the payment to providers.”

As a result, Friend said, doctors in Germany are supplementing their incomes with botox injections and renting out treadmill machines in their offices “and doing things to cover the bills.”

She added, though, that she was not opposed to universal health care. Getting there would be the challenge, she said.

Reid noted that German physicians pay no tuition to attend medical school — compared to American physicians who emerge from school with $200,000 of debt. And German doctors pay a nominal amount for malpractice insurance.

At the outset of his talk, Reid explored the philosophy of coverage before diving into a brief exploration of alternatives used by industrialized nations worldwide.

“In the first book of our Judeo-Christian Bible,” he said, “it asks a compelling human question: ‘Am I my brother’s keeper?’ And all the following books — the Old Testament and the New Testament — answer that question — yes, yes I am obliged as a human being to help others and particularly help them when they’re sick when they need our help.”

Veering to other systems, Reid noted there are a variety of approaches for industrialized nations other than the United States to deliver health care for all — not just a government-supported, single-payer system, roughly an extension of Medicare for all. Those countries include Japan, Germany, France, Switzerland, Canada, The Netherlands and Belgium.

He joked that there may be an effective way to persuade people in this country that it’s possible here, noting that a majority of Americans believe the current system needs repair.

“It’s a fundamental rule of the human existence that we ought to help others when they need help. And when they’re sick they need help,” he said.

“And that’s why these other countries want to provide health care for everybody. And my argument to you is, the United States could provide health care for everybody, I think we should provide health care for everybody, and we could provide health care for everybody because all of those countries like us already do.

“In fact, if anybody wants to leave early I can reduce my whole argument to a bumper sticker…If France Can Do It, the United States Can Do It.”